Wednesday, June 13, 2007

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Anatomy of the human spineThe spinal column (or vertebral column) extends from the skull to the pelvis and is made up of 33 individual bones termed vertebrae. The following figure shows the lateral and posterior views of the spinal column:

Between each vertebra are strong connective tissues which hold one vertebra to the next, and acts as a cushion between the vertebrae. The disc allows for movements of the vertebrae and lets people bend and rotate their neck and back. The type and degree of motion varies between the different levels of the spine: cervical (neck), thoracic (chest) or lumbar (low back). The cervical spine is a highly mobile region that permits movement in all directions. The thoracic spine is much more rigid due to the presence of ribs and is designed to protect the heart and lungs. The lumbar spine allows mostly forward and backward bending movements (flexion and extension).

What is a spinal fusion surgery?Fusion is a surgical technique in which one or more of the vertebrae of the spine are united together ("fused") so that motion no longer occurs between them. Bone grafts are placed around the spine during surgery. The body then heals the grafts over several months - similar to healing a fracture - which joins, or "welds," the vertebrae together.

When is a spinal fusion surgery necessary?Spinal fusion surgery is used to treat:• a fractured (broken) vertebra e.g. spondylolisthesis• deformity e.g. scoliosis or kyphosis (spinal curves or slippages)• pain from painful motion• instability• some cervical disc herniations (fusion together with discectomy)• weak or unstable spine caused by infections or tumors

Details of the procedure

What do I need to do before the surgery?• Follow your health care provider’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.• Take a shower and wash your hair the night before surgery.• Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the m morning before the procedure. Do not even drink coffee, tea, or water.• Follow any instructions your health care provider may give you.

What type of anesthesia will be used?You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and also prevents you from feeling pain.

What happens during the surgery?The surgical procedure involves placement of a bone graft between the vertebrae. The surgery can be done either from the front or back of the body. The surgeon will decide which approach is the best depending on the problem. In the neck, the anterior approach is more common; lumbar and thoracic fusion is usually performed posteriorly.

The vertebrae are joined together by adding bone in the space between the vertebrae. The soft discs between the bones are sometimes removed if they are causing pain. The pieces of bone are usually taken from the outer pelvic bone (autograft). Bone from a bone bank (allograft) may also be used. There is research being done with synthetic (man-made) bone rather than using real bone.

With some of the newer "minimally invasive" surgical techniques currently available, fusion may sometimes be done through smaller incisions. The indications for minimally invasive surgery (MIS) are identical to those for traditional large incision surgery; however, it is important to realize that a smaller incision does not necessarily mean less risk involved in the surgery.

After surgery the bone heals and fuses together with the vertebrae. The bone will heal better if the spine does not move. Spinal instrumentation, such as rods, plates, wires, or screws, may be put in the back at the same time as the spinal fusion to keep the spine from moving while it heals.

How long will I be in the hospital?Patients generally stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. A short stay in a rehabilitation unit after release from the hospital is often recommended for patients who had extensive surgery, or for elderly or debilitated patients.

What are the risks associated with spinal fusion?Risks for any surgery include bleeding and infection. Additional risks for spinal fusion surgery include urinary difficulties (retention) and temporary decreased or absent intestinal function.

How long will it take to recover?The immediate discomfort following spinal fusion is generally greater than with other types of spinal surgeries. Postoperative pain control methods including oral pain medications and intravenous injections help control pain. Another method is a patient-controlled postoperative pain control pump that delivers a predetermined amount of narcotic pain medication through an intravenous line.

What should I watch out for?Call your provider right away if:• The wound is bleeding or oozing fluid.• You develop a fever.• You become short of breath.• You are in a lot of pain.• You develop numbness or weakness.

What rehabilitation program is recommended after the procedure?Following spinal fusion surgery, a postoperative rehabilitation program may be recommended by your surgeon. The rehabilitation program may include back strengthening exercises and possibly a cardiovascular (aerobic) conditioning program, and a comprehensive program custom-designed for the patient's work environment in order to safely get the patient back to work. The decision to proceed with a postoperative rehabilitation program depends upon many factors. These include factors related to the surgery (such as the type and extent of the surgery) as well as factors related to the patient (age, health and anticipated activity level.) Active rehabilitation may begin as early as 4 weeks postoperatively for a young patient with a single level fusion.

When can I expect to return to work and/or resume normal activities?Recovery following fusion surgery is generally longer than for other types of spinal surgery. It also takes longer to return to a normal active lifestyle after spinal fusion than many other types of surgery. This is because you must wait until your surgeon sees evidence of bone healing. The fusion process varies in each patient as the body heals and incorporates the bone graft to solidly fuse the vertebrae together. The healing process after fusion surgery is very similar to that after a bone fracture. In general, the earliest evidence of bone healing is not apparent on X-ray until at least six weeks following surgery. During this time, the patient's activity is generally restricted. Substantial bone healing does not usually take place until three or four months after surgery. At that time activities may be increased, although continued evidence of bone healing and remodeling may continue for up to a year after surgery.

In addition to some restrictions in activity, a brace is sometimes used for the early post-operative period. There are many types of braces that might be used. Some are very restrictive and are designed to severely limit motion, while others are intended mainly for comfort and to provide some support. The decision to use a brace or not, and the optimal type of brace, depends upon your surgeon's preference and other factors related to the type of surgery.

What can I expect in the long run?Although fusion can be a very good treatment for some spinal conditions, it does not return your spine to "normal." The normal spine has some degree of motion between vertebrae. Fusion surgery eliminates the ability to move between the fused vertebrae, which can put added strain on the vertebrae above and below the fusion. Fortunately, once a fusion has healed, it rarely, if ever, breaks down. However, it does place more stress on the vertebrae next to the fusion. This has some potential to accelerate degeneration of those segments, but this risk varies between individuals. Many surgeons therefore recommend that spinal fusion patients avoid repetitive strenuous activities that involve combined lifting and twisting maneuvers to minimize the stress on the areas around the fusion.

Cost and availability

Which countries/hospitals is it available in?Click here to check the availability of spinal fusion surgery with our partner hospitals.

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Note: All information presented here has been obtained from publicly available medical resources and is here for reference purposes only. Healthbase does not claim to be a medical professional and does not provide any advice on any issues relating to medical treatment.